Twelve Month Visit

Development

One of the most important milestones is pointing. Your child should see something, wonder what it is and point as if to ask "what is it? Or "look at that." Other social skills include making eye contact with you for reassurance and some parallel play with other children.

Learning to walk allows your baby to become more autonomous and more able to explore. By 15 months of age, most children are walking independently and starting to run.

The 12-month-old child's babbling becomes more melodious and complex. He/she will respond to their name when called. He/she will begin to use mama and dada appropriately. Comprehension is often greater than expression at this age.

Over the next few months hand preference may appear. Your child will start to scribble and imitate a drawn line. They will start to remove articles of clothing.

Activities

Play, talk and read with your baby. Point to body parts and name them.

Sing with your child. Sit together and play with simple sound making toys such as a xylophone. Play the piano together.

Roll a ball back and forth and play other "give and take" games. Put toys and objects in and out of containers.

Use push/pull toys, washable markers to scribble.

Introduce counting. Give sequential directions to follow.

TV and video are not recommended. Early screen time is not beneficial to development.

Safety

Curiosity and energy are not balanced by judgment at this age. You must closely supervise your toddler. Don't let them wander around a house without you.

Never leave your child unattended or supervised by an older child around water, pools or the bathtub. Locks on doors are essential if you live near the water.

Be very clear about street and parking lot safety. Always hold hands or carry your child.

Never allow a child to "play" unaccompanied in the car.

Choking remains a hazard. Watch play areas carefully for small objects since your explorer will find every little thing that drops on the floor. Keep your child away from balloons and plastic bags. Check toys carefully for breakage, sharp or small parts.

Protect your child from falls: secure stairways, doors, windows and screens. Secure heavy objects such as bookshelves, TVs and furniture. Put away coffee tables for the next few months.

Use a properly fitting car seat. The center rear seat is the safest position. A rear-facing car seat should be used until your child is AT LEAST one year of age AND 20 lbs (www.carseat.org).

Never hold a baby while drinking a hot beverage or smoking.

Check your smoke detectors and fire extinguishers on a regular basis. Have a family fire exit plan with ladders in upstairs bedrooms.

Avoid direct sunlight; sunburns happen easily. Apply baby sunscreen.

Do not use walkers with wheels. They are associated with serious injury. Stationary devices such as Exersaucers or Johnny Jump Up exercisers are good substitutes.

Poisoning are common events. Lock up medicines, cleaners, detergents, & antifreeze. Syrup of Ipecac is no longer recommended for home treatment of poisoning by the American Academy of Pediatrics, although some experts continue to recommend its use in certain situations. In case of ingestion of poisons, call the Poison Control Center (1-800-222-1222).

Respond in a positive way to good behavior. Be very consistent and clear. Keep "rules" to a minimum.

Temper tantrums and negativism are a normal pat of this stage of development. Stay calm. Don't overreact. Try to understand what your child is asking, respond clearly, suggest an alternative and then allow him/her to handle the tantrum on his/her own. Tell him/her you will be there when he/she is finished with the tantrum.

Respect your toddler. Ask if he/she is finished eating before taking him out of the highchair. Give warning when an activity is about to change. Help him/her communicate and cooperate by giving him/her the opportunity. Narrate your day; talk about what you are doing and seeing.

Provide freedom to explore safely.

Maintain your bedtime ritual. Usually children change to one mid-day nap by 15 months.

Nutrition

Typically children this age eat three meals a day and two snacks. Eat as a family. Start working to make one meal for everyone. Avoid choking foods such as peanut, popcorn and raw vegetables.

If you are still breastfeeding your toddler, congratulations!! You're doing great!. You've given your baby one of the most precious gifts that only you can give him. Breastmilk continues to be important to your baby from a nutritional, immunological and psychosocial standpoint. You should continue to nurse him as long as you want to. Some babies will start the weaning process on their own around this time. Some will continue to nurse for a few more years if you allow it. The World Health Organization recommends breastfeeing for two years or longer.

Weaning should happen when the mom and/or the baby are ready. You may work on night weaning by letting dad put the baby to sleep and comfort him when he/she wakes up at night.

Continue to supplement with vitamin D, 400-600 IU/day.

Toddlers tend to be picky eaters. Make sure the foods that you offer are rich in nutrients. Avoid empty calories, junk foods. Make sure your toddler is eating plenty of colorful fruit and veggies, moderate amounts of carbs and a reasonable amount of protein and good fat. If you are vegetarian, make sure your toddlers diet has a good amount of legumes: beans and pulses. Black eyed peas, chick peas, lentils, lima-beans etc are rich in protein, iron, carbs and soluble fiber. They should be a staple in your vegetarian baby's diet.

Switch from formula to whole milk with a target of about 12 to 16 oz. of whole milk a day. Don't worry if he does not drink milk. You may give him other dairy products such as yogurt, cheese and cottage cheese. Serve milk in a cup at mealtimes. Keep trying the cup even if your child doesn't seem to be successful at first. Plan to phase out the bottle by 15 months. Too much milk depletes a child's appetite for more iron rich foods.

Appetite highs and lows are expected. Your job is to offer healthy foods. Your child's job is to eat healthy foods when they are hungry. Don't worry if they don't each much one meal. Model good nutrition.

Spoon skills are improving. Allow your child to feed him/herself. Let them explore and make a mess.

Mealtimes, especially dinner, should be a family affair. Always sit down with your family for dinner. You may feed your child but do not chase him/her with a spoon. Do not watch TV while eating. Mealtimes should be relaxed and fun. It should be a time when you catch up on each other.

Immunizations Today

Your child may receive the Chickenpox, Pneumococcal conjugate and the Hepatitis A vaccines today. This vaccine can have a delayed fever and/or rash reaction 6-10 days later.

Next Visit

Please make an appointment as you leave today for when your child is 15 months old.